A study about total pulmonary replacement with artificial intra-thoracic implantable lung.

目前，右室心功能不全(RVF)多采用RVAD治疗。在临床上，RVF患者常因心力衰竭而导致气体交换不良。本研究的目的是探讨无泵ECMO在右室-左房转流中作为治疗慢性右室颤动的有效手段。实验一：杂种犬10只，体重2.5~6.0 kg，平均3.9 kg，行主肺动脉结扎术。在长期饲养(97-205天，平均160天)后进行右心压力研究。所有病例的平均右室压(m-RVP)[毫米汞柱][大于或等于]20(平均30)。实验II：10只RVF模型在右室出口与左房之间植入人工肺(MENOX EL2000，Kuraray Co.)。术中失去1只动物，用9只(4.8~8.4 kg，平均6.5 kg)评价气体输送和心功能。所有病例RV-LA转流后m-RVP均与术前持平或下降，平均m-RVP(20.7±4.2)mm Hg，心功能有改善趋势。实验三、实验二结束后，9只犬结扎右室-左房，开始全右室-左房转流。9只RVF模型中，5只(4.8~8.4 kg，平均6.6 kg)支持6h以上，评价气体转运和心功能(I组)，另4只因RVF结扎大动脉后即刻死亡。另设5只非PA带膜肺的杂种犬作为对照(II组)。I组和II组的气体转移率均较好，平均为32.5±8.3ml/min。02ml/min和37.2±11.6ml/min。RV-LA与商用膜式氧合器之间的部分转流比完全转流对RVF的恢复效果更好。

At present, RVAD is commonly used for a right ventricular failure (RVF). In clinic, RVF patients usually suffer poor gas exchange due to cardiac failure. The purpose of this study is whether pumpless ECMO in right ventricle (RV) to left atrium (LA) bypass could be useful as a means of a treatment for a chronic RVF. Experiment I. Ten mongrel dogs (2.5-6.0 kg, mean 3.9kg) were performed banding of the main pulmonary artery (mPA), aimed for RVF due to pulmonary hypertension. A pressure study of the right heart was performed after a long term raising (97-205 days, mean 160 days). All the cases showed the mean RV pressure (m-RVP)[mmHg]【greater than or equal】20 (average 30. 2±9.0 mmHg).Experiment II. Implantation of the artificial lung (MENOX EL2000, Kuraray Co. Japan) was perfomed between RV outlet and LA for ten of the RVF model. As we lost one animal during operation, nine (4.8-8.4kg, mean 6.5kg) were used to evaluate the gas transfer and the cardiac function. All the cases showed the m-RVP (average 20.7±4.2 mmHg) after the RV-LA bypass was equal to the preoperative value or dropped, and the average cardiac function tended to be improved. Experiment III. After experiment II, the nine dogs were performed ligation of mPA and total RV-LA bypass was started. Five (4.8-8.4kg, mean 6.6kg) of nine RVF model were supported over 6 hours and evaluated the gas transfer and cardiac function (group I), while the other four died soon after ligation of mPA due to RVF. Five non-PA banding mongrels with the memnbrane oxygenator were used as control (Group II). Group I, aswell as Group II, showed good gas transfer rates, averages of 32.5 ± 8.3ml/min. of 02 and 37.2±11.6ml/min. of C02 with a blood flow rate of 0.68±0.19 L/min.A partial bypass between RV-LA with the commercially available membrane oxygenator provides better recovary of RVF than a total bypass in RVF model.